Provider Demographics
NPI:1508042086
Name:HUDSON VALLEY LTC PHARMACY INC
Entity Type:Organization
Organization Name:HUDSON VALLEY LTC PHARMACY INC
Other - Org Name:HUDSON VALLEY LTC PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-457-5040
Mailing Address - Street 1:105 WARD ST STE A
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-1150
Mailing Address - Country:US
Mailing Address - Phone:845-457-5040
Mailing Address - Fax:845-457-5085
Practice Address - Street 1:105 WARD ST STE A
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-1150
Practice Address - Country:US
Practice Address - Phone:845-457-5040
Practice Address - Fax:845-457-5085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
NY0283503336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02949948Medicaid
3357286OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY02949948Medicaid